Mindfulness Based Relapse Prevention for Stimulant Users

描述（由申请人提供）：当前研究的广泛、长期目标是通过创新的基于冥想的策略来增强传统的复发预防疗法，以提高影响调节技能，从而改善兴奋剂使用障碍的治疗。基于基于正念的抑郁症认知疗法（Segal, Teasdale, & Williams, 2002）， Marlatt及其同事最近开发了一种用于药物使用人群治疗的手动干预：基于正念的复发预防（MBRP）。本研究的具体目的是：1)进行一项随机临床试验，以评估招募和保留个体进行大规模研究的可行性，并确定在接受应急管理（CM）的兴奋剂使用者中，MBRP相对于健康教育（ED）对照组的效应大小。MBRP和ED参与者将在基线、治疗结束和治疗后1个月进行评估。2)比较MBRP与ED对消极情绪、兴奋剂使用和医疗保健结果的影响。3)评估MBRP与ED对参与者hiv风险行为的差异影响；4)研究MBRP的潜在作用机制，包括降低应激反应性和唤醒的生物学指标，如血压和心率。我们假设MBRP在减少负面影响和兴奋剂使用方面比ED更有效。此外，我们预计MBRP将大大减少hiv风险行为、应激反应和觉醒，这些变化将与药物使用结果有关。MBRP结合了特定的以物质为中心的认知治疗技术，并额外强调了正念技能。通过提供应对技能来解决影响调节和应激反应这两个兴奋剂复发的重要因素，MBRP可能为兴奋剂使用者的治疗提供一个有希望的增强策略。

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to improve treatment for stimulant use disorders by augmenting traditional relapse prevention therapy with innovative meditation-based strategies to promote affect regulation skills. Based on Mindfulness-Based Cognitive Therapy for depression (Segal, Teasdale, & Williams, 2002), Marlatt and colleagues recently developed a manualized intervention for the treatment of substance using populations: Mindfulness Based Relapse Prevention (MBRP). The specific aims of this research are 1) To conduct a pilot randomized clinical trial to assess the feasibility of recruiting and retaining individuals for a large scale study and to determine the effect size of MBRP relative to a health education (ED) control group in stimulant users receiving contingency management (CM). Both MBRP and ED participants will be assessed at baseline, treatment-end, and 1 month post-treatment. 2) To test the impact of MBRP compared to ED on negative affect, stimulant use, and healthcare outcomes. 3) To evaluate the differential effects of MBRP versus ED on HIV-risk behavior of participants, and 4) To examine potential mechanisms of action of MBRP, including reductions in stress reactivity and biological indicators of arousal such as blood pressure and heart rate. We hypothesize that MBRP will be more efficacious than ED in reducing negative affect and stimulant use. Further, we expect that MBRP will produce greater reductions in HIV-risk behaviors, stress reactivity, and arousal, and these changes will be associated with substance use outcomes. MBRP incorporates specific substance-focused cognitive therapy techniques with an additional emphasis on mindfulness skills. By providing coping skills to address affect regulation and stress reactivity, two important factors in stimulant relapse, MBRP may provide a promising augmenting strategy for the treatment of stimulant users. PUBLIC HEALTH RELEVANCE: Relevance to Public Health: The proposed research is of considerable public health significance in that it will provide foundational information on Mindfulness Based Relapse Prevention as an intervention for stimulant dependence, a serious drug problem with extensive impacts. If proven effective, the protocol could be useful in treating addiction and in reducing stimulant use among treated individuals, thereby efficiently reducing drug abuse and related consequences such as criminal activity, social disruption, and elevated risk of HIV transmission/infection due to increased frequency of unsafe sexual activities, a particularly prominent problem among stimulant users. The proposed project will determine clinical utility of an innovative intervention protocol previously untested in stimulant-dependent individuals.